Chiari Malformations Abstract V

Does Chiari Malformation Contribute
To Fibromyalgia (FM) Symptoms?

Alarcón GS, Bradley LA, Hadley MN, Sotolongo A, Alberts KR, Martin MY, Aaron LA, Weigent DA, Gammal T El, Mountz JM, Blaylock JE, Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL 35394

AIM: Examine relation between FM and Chiari malformation and compare clinical symptoms and cerebrospinal fluid (CSF) levels of substance P (SP) in persons with either FM only, Chiari only, or FM and Chiari.

METHOD: We studied 64 subjects: 30 (29W, 1M) rheumatology clinic patients who met ACR criteria for FM, 12 (12W, 0M) community residents who met ACR criteria for FM but had not sought treatment (nonpatients), 16 (16W, 0M) healthy community controls, and 6 (5W, 1M) patients with Chiari only and significant bulbar/spinal cord compression requiring spinal surgery. An experienced neurosurgeon and neuroradiologist read all subjects’ blinded and coded brain MRI(s) obtained for an ongoing pain study using standard criteria for presence of Chiari. Patients and nonpatients completed McGill Pain Questionnaire and Fatigue Severity Scale. CSF SP (57/64 subjects) measured by RIA. Statistical analyses performed with chi-square and ANOVA.

RESULTS: Readers reliably (kappa= .64) identified Chiari in 6 (20%) FM patients, 0 FM nonpatients, 1 (8%) control, and all (100%) Chiari only patients. FM patients strongly tended to show Chiari malformation more frequently than FM nonpatients and controls (p= .07). Chiari only patients showed significantly (p<.0001) higher mean ( + SE) CSF SP (58 + 22.0 fmale/ml) than both FM patients (22.3 + 1.9) without Chiari and nonpatients (18.7 + 1.9) who, in turn, showed significantly higher mean CSF SP (p<.05) than healthy controls (13.3 + 1.4) without Chiari. FM patients with and without Chiari did not differ in CSF SP (p + .91) or ratings of pain (p= .41) and fatigue (p= .98). One FM patient with Chiari who required surgery for worsening symptoms of compression did not differ from FM patients without Chiari in pain or fatigue ratings but showed CSF SP level (41 fmale/ml) similar to those of Chiari only patients. The control subject with Chiari showed normal CSF SP (3 fmale/ml).

CONCLUSION: (1) Chiari tends to be associated with FM among rheumatology clinic patients although it generally does not elevate levels of CSF SP, pain, or fatigue; (2) All FM patients should be examined for signs of bulbar/spinal cord compression and those with evidence of compression should be referred for MRI; (3) A small number of the FM patients with Chiari may require and benefit from surgery.

1997 American College of Rheumatology Meeting, Abstract No. 953